Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 7
Medicine and Surgery in the Third World
Lawrence Levy
Between two-thirds and three-quarters of the world’s population live in the developing
world, yet most of the money and other resources are in the so-called developed
world. In almost every field the differences between the two are immense.
What may be considered to be “no money” in one place might well be considered a
fortune on the other side of the globe. Similarly in matters of housing and education
and in consequence health, the difference is extreme. It is well accepted that good
health has relatively little to do with the health services offered, but much to do with
the standard of living and education. Where overcrowding is reduced, and clean
water, good sanitation and adequate food are available, the health of the people
improves immensely. Nonetheless people still suffer disease and sickness and the
health services have a very large part to play in all societies, rich and poor, though
the part there is to play differs immensely. In the developed world the emphasis is
inevitably towards the curative side, so many, though not all, of the major “public
health” problems having been controlled; by contrast, in the developing world the
emphasis is inevitably much more oriented towards prevention and primary health
care because of the nature of the disease patterns. However, this is not to imply that
the therapeutic services have no place; they have an enormous part to play.
Using East and Southern Africa, with which the author is most familiar, as an
example, though the situation is known to be very similar elsewhere, between 70
and 80% of the population is rural and agriculturally based. However in most cases
the agriculture is of a simple nature rather than intensive profit-making cultivation.
Despite attempts to provide machinery to assist with ploughing and harvesting, the
majority of rural people are dependent upon the ox or the ass or human endeavour
for motive power. The situation becomes much worse for these people in times of
drought, as occurs from time to time throughout the Third World and as the draft
power dies from lack of food and water. Despite massive efforts by governments to
provide bore holes there are still large areas in which the water supply is, at best,
parlous. Starvation in these areas is inevitable and endemic, and dirt diseases ever
present. The author recently visited a rural health centre where water had to be
brought daily in a barrel by wheelbarrow a distance of 2 km; when the strong man
whose job it was to transport the water was off duty, that which could be carried by
nurses in buckets was all that was available. This situation is repeated many times
throughout the Third World. In many rural clinics at night only candle power is
available, delivering a mother at that time can be a hazardous business for patient
and attendant. It has been the aim of the Zimbabwe Health Services to provide
sufficient points of access to the health care system that no person should have to
walk more than 10 km to reach such a place. Regrettably, although enormous numbers
of health centres have been built, there are sparsely populated areas where the
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.